Don't Praise the Insurance Murderer
The grainy December 4 surveillance footage showed a man in a hoodie firing multiple shots into UnitedHealthcare CEO Brian Thompson before he escaped on a bicycle. Near Thompson’s corpse, police found ammunition inscribed with the words “deny,” “defend,” and “depose,” suggesting someone with a grudge against insurance companies. (“Delay, deny, defend” is the way many lawyers describe insurance company tactics used to avoid paying out money.)
Five days later, Pennsylvania police arrested Luigi Mangione at an Altoona McDonald’s and charged him with murder. In addition to a gun like that used in the killing, Mangione had a note seemingly confessing to the crime (although, for now, he has not pled guilty).
…it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. [Mangione is wrong. UHG is 17th by market cap.] It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it…
Thompson was married with two kids. He was rich but came from modest roots (his father had been a grain elevator worker, his mother a beautician), unlike Mangione, a scion of a very wealthy Pennsylvania family, who went to an elite Baltimore prep school and received two degrees from the University of Pennsylvania.1
Shocking to me, many Americans on social media showed no sympathy for Thompson.2 Instead, they said he got what he deserved because he was a health insurance executive. Many treated Mangione like an outlaw folk hero.3
The replies on an NPR Facebook post were typical:
Others didn’t say the murder was justified but suggested it was at least understandable. Talking to Joy Reid on MSNBC, Senator Elizabeth Warren said, “Violence is never the answer…but you can only push people so far, and then they start to take matters into their own hands.”
Late-night talk show host Jimmy Kimmel featured a segment showcasing staffers’ texts thirsting for the alleged murderer because he was a hottie. Mega-millionaire Kimmel called the murder of a man whose two sons, 16 and 19, will never feel his hugs again “a crime we can relate to.”
When I pushed back against this POV and tweeted, “Insurance executives are not murderers,” more than 1000 people replied, most disagreeing with me.
This is madness.
We sign contracts with for-profit health insurance companies, knowing they will pay out less than we put in. We also know in advance that they will keep some money back for expenses and profit. That’s the bargain! The same is true for life insurance and homeowner’s insurance.
Even if they weren’t for-profit corporations, they could not give everyone all the money they wanted every time they wanted it. Doctors and hospitals always push for more tests and procedures than are necessary. They leave it to the insurance company to play the bad guy. If insurance companies paid out every claim in full, they would go broke!
Economist Noah Smith argues that insurance companies aren’t the main problem; rather, it’s the high amounts charged by providers. UnitedHealth Group (United Healthcare’s parent company) had a net profit of 6.11%. (Despite what Mangione's manifesto says, this is not large. The average net profit of the S&P 500 in the first two quarters of 2024 was at least 12%.) About 83% of the premium income goes to pay medical costs. An ambulance ride in New York City will cost you at least $1385. The national average for an MRI is $1325. A typical colonoscopy is $2750. American medicine is expensive.
The rest of UHG’s income covers operating costs and that 6.11% profit.
A reminder: There is not an unlimited supply of healthcare that nasty insurance companies are keeping from us. Doctors, nurses, ambulances, and expensive hospital equipment are all in limited supply. If I’m seeing my doctor, you can’t see her. If I’m having a cardiac ablation, that 8-person team isn’t available to fix your heart. Healthcare is a scarce resource. In America, we regulate that scarcity using money mediated by insurance companies. Countries with more socialized medicine tend to regulate it with different kinds of gatekeeping, including both turning down patients for procedures and (more often) putting them on waiting lists.
A 2023 Guardian article reported that over 120,000 people died on National Health Service waiting lists in 2022. Many of these would have died even with treatment, of course, but some could have been saved. English NHS employees decide who goes on the front of the line, and sometimes they make the wrong call.
“Record numbers of people are spending their final months in pain and agony, waiting for treatment that never arrives,” said Wes Streeting, the shadow health secretary. “The basic promise of the NHS – that it will be there for us when we need it – has been broken.”
I saw this firsthand yesterday. A Canadian Twitter follower of mine, Adam Burgoyne (@big_figgot), posted that he’d had a health scare and gone to the hospital. They did a quick check to see if he was dying and then put him in the waiting room. Six hours later, he gave up and went home. That was December 5. Later, he died of an aortic aneurysm. He was 39. Rest in peace, Adam.
No matter what system you use, there will be gatekeepers. Whether they are private insurance doctors ruling on whether your expenses are covered or public bureaucrats deciding where to put you on a waiting list or in a waiting room, someone will make the call, and sometimes, that call will result in tragedy. This is inevitable.
Of course, this doesn’t mean that companies like UHG always make good choices. An October Senate report, “How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care,” outlined how UHG used AI to turn down patients asking for post-acute care (care after severe illnesses).
The suit continued arguing that despite the high error rate, the company and its subsidiary "continue to systemically deny claims using their flawed AI model" because they know that only about 0.2% of policyholders will actually appeal denied claims and that the vast majority will either pay out-of-pocket costs or forgo the remainder of their prescribed post-acute care.
That sounds quite bad, but UHG is a for-profit company. Working hard to avoid paying out too much (by their definition) is how they make a profit. They may have crossed an ethical line in their use of AI, but we shouldn’t be surprised that the capitalist company that we hired to insure us behaves like a capitalist company.
This doesn’t make insurance executives like Brian Thompson murderers.
“Yes they are, they just do it through paperwork.”
That’s simply not the same. Imagine Sally needs possibly life-saving heart surgery. UHG rules the care is not covered (maybe she’s a bad risk, maybe the AI made a mistake). Sally dies. Is her death partly UHG’s fault? Perhaps, but they didn't kill her; a bad heart valve killed her. “But UHG could have saved her!” Perhaps, but that’s not the same. The hospital could have saved her, too, but they decided not to work for free. You could have saved her by handing over $100,000, but I don’t think you would.
None of this means that America’s dependence on private insurance is the best we can offer or to deny the insurance horror stories we’ve all read. But every system will have those stories some of the time. Sometimes, the system will not “be there for us when we need it.”
Could America do better? Matt Bruenig—a smart left-wing pundit—wrote a piece for the even more left-wing Jacobin arguing that our system is overpriced due to bloated administrative costs.
They [insurance companies] are directly responsible for over half a trillion dollars of administrative waste and (at the very least) indirectly responsible for the provider rents that are bleeding Americans dry. The quicker we nationalize health insurance, the better.
So perhaps our best choice is to replace our system with something like England’s or Canada’s. But none of that means that our current system is run by murderers who deserve to be executed by good-looking vigilantes.
You disagree? Fine. Let’s follow this argument to its logical conclusion. Brian Thompson was a mass murderer. They are all mass murderers. Every single insurance executive. Letting them walk free is an offense to justice. There are already “WANTED” posters with health insurance CEOs’ names and faces pasted around New York City. Pick those bastards up. Throw them all in jail today! Or send them to the guillotine! Madame Defarge awaits!
If they are truly evil and worthy of execution, as so many claim, their companies must be dissolved. Yay! No more insurance companies!
And tomorrow, when you need to go to a clinic for an endoscopy or visit the hospital for that gallbladder operation? I hope you have lots of cash, or your hospital won’t admit you, and your surgeon won’t operate. We can build a new system—with a gaggle of new problems—but that will take years. In the meantime, there will be unimaginable chaos, and the suffering of those without fat bank accounts will be immense.
Sure, my picture is crazy, but don’t blame me! Blame everyone calling Thompson a murderer. If the health insurance business is genuinely evil and its participants deserving of execution, the plug should be pulled immediately.
The adult reality is that Thompson was an imperfect man working in an imperfect industry. If we don’t believe healthcare should be a for-profit enterprise, the solution lies in electing legislators committed to building a better model. Addressing our troubled healthcare system requires political action, not demonizing or murder.
Just be warned, whatever new system we create will have its own injustices and victims.
Do you still think Thompson was complicit? Perhaps you’re right, but then maybe most of us are. Do you work for a petroleum company? A bank? A casino? Whatever you do, someone probably thinks it’s evil. I just came back from a Las Vegas trip that cost me a few thousand dollars. That’s money I didn’t give to charity or use to pay some poor person’s medical bills.4 Maybe I’m the bad guy.
And what about you? Make any unnecessary purchases lately?
Although Mangione may lose out on some of that wealth, TMZ discovered that his grandmother’s will excludes anyone charged with a crime. Mary Mangione was estimated to have had an estate of 30 to 100 million dollars. (With 10 children and 37 grandchildren, Luigi Mangione’s share might be relatively modest.)
Although loud, these pro-Mangione Americans are a minority. According to a CSP poll, only 6% of Americans thought Thompson’s murder was “justifiable,” and another 6% thought it was “somewhat justifiable.” Another 15% said it was “somewhat unjustifiable,” and 58% said it was “very unjustifiable.”
Still, only 58% being absolutely against murder is not a cheery number for those of us who are anti-murdering people on the street.
John Dillinger (1903-1934) led a gang of bank robbers and became a folk hero during the Great Depression. He and his gang killed ten men.
Undue Medical Debt is a 4-star charity (the highest rating given by Charity Navigator) that pays off the medical bills of those in need.
That you have to even write this is deeply worrying.
It's amazing to me this even has to be explained to people. I saw a good line on twitter, the fact that abortion clinics get bombed means that we need to listen more to the bombers because they are a wake up call to the horrors of abortion. Noooo.
Also people who say medicare for all is the answer, I wonder if they realize medicare stops more procedures and help than private insurers, and the only way Dr.'s make it right now is by getting higher pay from private insurers. The private system is supporting medicare. If we put everyone on Medicare there will be even less money in the system to pay for everything than there is now. It won't work without enormous taxes and a way to control free riders like illegal immigrants using the system.
Another problem here is that if Medicare turns down a drug or procedure, you can't private pay it yourself like you can with a private insurer. The Dr.s won't do it because Medicare will sanction them. Even if you pay for it yourself.
Be careful what you wish for, you just might get it.